Provider Demographics
NPI:1689792939
Name:LONSDORF, NANCY K (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:K
Last Name:LONSDORF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1480
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-0025
Mailing Address - Country:US
Mailing Address - Phone:641-469-3174
Mailing Address - Fax:877-603-3125
Practice Address - Street 1:1100 N 4TH ST STE 211
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-2169
Practice Address - Country:US
Practice Address - Phone:641-469-3174
Practice Address - Fax:877-603-3125
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25776208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAB92865Medicare UPIN